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Related Concept Videos

Diagnosing Acidosis and Alkalosis01:24

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Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
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Assessing Acid-Base Status: Physiologic Versus Physicochemical Approach.

Horacio J Adrogué1, Nicolaos E Madias2

  • 1Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Medicine, Methodist Hospital, Houston, TX; Renal Section, Veterans Affairs Medical Center, Houston, TX.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|September 4, 2016
PubMed
Summary

Understanding acid-base status requires grasping both the traditional physiologic and newer physicochemical approaches. This teaching case contrasts these methods to improve clinical assessment and patient care.

Keywords:
Stewart approachacid-base disordersacid-base statusanion gapbase excessdiagnosisphysicochemical approachphysiologic approach

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Area of Science:

  • Biochemistry
  • Physiology
  • Clinical Medicine

Background:

  • The physiologic approach to acid-base status views it as a balance of hydrogen ions and buffers, primarily using the carbonic acid/bicarbonate system.
  • The physicochemical approach, gaining traction among intensivists and anesthesiologists, analyzes acid-base balance through three independent variables: strong ion difference, weak acid concentration, and PCO2.

Observation:

  • Practitioners are often familiar with only one of these acid-base assessment methods.
  • A knowledge gap exists regarding the principles, advantages, and limitations of both the physiologic and physicochemical approaches.

Findings:

  • The physicochemical approach determines hydrogen and bicarbonate concentrations mechanistically from independent variables.
  • The carbonic acid/bicarbonate buffer system is central to the physiologic approach, with pH dependent on PCO2 and bicarbonate levels.

Implications:

  • Bridging the knowledge gap between these two approaches can enhance clinical understanding of acid-base disorders.
  • Applying both methods to patient cases can clarify their respective strengths and weaknesses for optimal clinical decision-making.